Advanced Pharmacology: Inotropes & Vasopressors

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Transcript of Advanced Pharmacology: Inotropes & Vasopressors

Advanced Pharmacology: Inotropes & VasopressorsRAH Emergency DeptMarch 2016What is an inotrope?drugs that affect the force of contraction of the heartinfluence how effective the heart can pumpPositive Inotrope: stimulate & increase the strength of the heart muscle contraction causing the heart rate to increasedNegative Inotrope:drugs that weaken the force of myocardial contractionsMetoprololDigoxinCalciumProcainamideAmiodaroneDopamineDobutamineEpinephrineDiltazemIsuprelMilrinoneLabetalol Key Points of Inotropic Drugs:

Extremely short half life

Caution in hypovolemia

Titrate to desired effect

Administration has to be accurate & infusion pump required

Dedicated infusion line

Caution in peripheral lines, can cause extravasation

Caution if patient is volume overloaded

Ensure oxygen demands are continually being metWhat is a Chronotrope?drugs that may change the hearts ability to increase its rates with increased activity or demandPositive Chronotrope:drugs that increase heart rateNegative Chronotrope:drugs that reduce the heart rateWhat is a Dromotrope?drugs that affect the heart rate by affecting the conduction speed at the AV junction

they are often, but not always, inotropic and chronotropic as well

Ex.) Calcium Channel BlockersWhat is a Vasopressor?drugs that induce vasoconstriction

elevates the mean arterial pressure (MAP)

differ from inotropes, however many drugs have both vasopressor and inotropic effectsAdrenergic ReceptorsDopaminergic ReceptorsPredominant catecholamine neurotransmitter in the brain

decreases vascular resistance by causing vasodilation and venous poolingWhat's the dose?Continuous infusion2 to 10 mcg/minute or 0.01 to 0.2 mcg/kg/minute, and titrate to responseThe odd one out....VasopressinHow does it work?antidiuretic hormone

synthesized in the hypothalamus

stored in the posterior pituitary

potent stimuli for release includes hypotenion, hypovolemia and hyperosmolality

can cause bronchial constrictionLet's put it into practice....Before initiating vasopressor or inotropic support, it is crucial to correct what state?

Case StudiesSue is a 24 year old female who is 12 wks pregnant. Her husband brought her to the ED when she passed out at home. On route she began vomiting and complaining of severe RLQ pain radiating to her suprapubic area and Rt shoulder.

General Appearance: diaphoretic, cool, clammy skin, she is moaning and guarding her abdomen. Restless, GCS 15